Friday, 30 May 2014

Against Mindfulness

Mindfulness, it gets everywhere. From mental
health services, to schools and into the House of Commons pupils,prisonersandpoliticiansare
taking a breath, holding that thought and just...noticing. It begins to feel like Woody Allen’s vision of 1970s New
York, where everyone is in psychoanalysis. Mindfulness is not just a new form
of treatment, it is a way of life for growing numbers of people.

I must confess to some desire to provoke in
choosing the title for this post. I am no more ‘against’ mindfulness than I am
against psychotherapy, formulation or exercise. Mindfulness evidently has a
place in the spiritual lives of many, and in mental health services, as a form
of anxiety reduction, as a way to get people in touch with their inner world,
as a way to manage the agony that some people feel in simply being alive.
However, what I am against is a
certain breed of unbridled enthusiasm that can make innovations like
Mindfulness seem like they are not only magically transformative but alsomandatory. Despite the reserve of its
promoters (on full and worthy display in the excellent Guardian articlehere) the way Mindfulness is spoken about,
written about and thought about suggests caution has been thrown increasingly
to the wind.

Psychotherapeutic innovations, much like
medical innovations, travel on a wing and a prayer. We try something out for X
and find it helpful, so it makes good sense to consider applying it to Y. It is
no wonder that Mindfulness has moved from being a way to managestress and illness, to being a component ofmajor treatment for borderline personality to
being adepression intervention and way beyond.

There is talk of a move toward the use of
Mindfulness in thetreatment of psychosis. When Peter Liddle and
his colleagues found an association between psychosis and a disruption to the
insula-frontal loop that regulates salience,it was suggested Mindfulness might play a role
in boosting insula function if practiced hard enough to increase the density of
the brain. It’s early days yet, and one can easily imagine that the capacity to
differentiate different internal states could be very beneficial for people in
whom this capacity gets disrupted. However, given that psychosis has long been
theorised as a breakdown in the basic integrity of the sense of self (seeherefor
a phenomenological account and here one focused more on cognitive
neuroscience), the deployment of an intervention that promotes further flight
from the ego seems to me to be a step we should be taking verycautiously indeed.

Awareness of one’s existential states is not
unique to Mindfulness, it has a rich tradition in psychoanalytic and
phenomenological psychology and is a wonderful autonomy granting thing. The
integrative psychotherapist Paul Wachtel has suggested that, in terms of
self-observation, there is a huge overlap between the internal mental focus of
psychoanalysis and the focused breathing activities of behavioural anxiety
reduction. So why has this Buddhist variant been such a smashing success
recently? A sceptic might suggest an element of faddism, and I would humbly
submit they could be onto something. This is not to say there is anything
faddish about regular meditative practice, it’s strenuous and disciplined, for
at least some proportion of the
people who undertake it.

Mindfulness appears superficially to sit
quite well with a holistic and political approach to mental health, but it also
promotes a degree of distance from emotion. This distance can be invaluable,
but there are emotions, even quite unpleasant ones, whose force it can be worth
retaining. Emotions are our lifeblood, the fuel for our internal moral engines.
‘What’s that you say, you’ve furious because you live in a structurally unfair
society?.....And breathe.’

This is all somewhat facetious; the obvious
reply is that if Mindfulness detaches you from your emotions then it is not to
nearly the same extent as psychoactive medications. Quite right; my point is
that if one part of mental health care is helping us get some distance from our
emotions, another part is helping us get back in touch with them. This point
has been made in the field of politics, where it is argued (most often byrevolutionary Marxists, it has to be said)
that cultivating a radical acceptance could also induce an unhealthy degree of
apathy. In short, acquiring Mindfulness about disabling levels of anger, terror
or regret may be the easy part. If it were all your psychologist had to offer,
you might reasonably feel short changed.

Mindfulness, it is often said, is partly
about getting in touch with the fact there is no basic self.Some cognitive scientists feel similarly, but
barring any sudden metaphysical breakthroughs, we can safely say that the issue
is moot. Personally I rather like having a self, and for the time being my
university, my family and the taxman all seem to agree it exists (try arguing
it wasn’t you that spent all that money on cake last month). There is something
like a Huw there, I may as well get to know him.

My own relationship with Mindfulness is of
course coloured by my personal tastes. Inner awareness can also come from
therapy, from conversation and in the form of extended daydreaming and reverie;
the fascination of realising ‘oh that pissed me off, I wonder why?’ and the
tremendous power of not reacting on impulse. I have spent quite a lot of time
in my own head over the course of my life and with that has come a distance
from immediate reactions, which has often served me well. We should strive to
maintain the deepest respect for people’s relationships with their minds,
however religious, secular or simply idiosyncratic they may be. The question
for the psychologist is how to engage with different approaches to life without
ever becoming proselytisers.

Mindfulness arises out of an ancient
theological system far more complex than can possibly be credited in the
numerous books that now fill the self help sections. The current western
fashion does something rather tawdry to this historical legacy, seeming to don
it as easily as a cheap pashmina. I have no principled stance against the
secular appropriation of religious activities (I celebrate a fairly Godless
Christmas), but many of the now widespread uses of Mindfulness, and of Buddhism
in general, leave me cold.

6 comments:

While I value aspects of mindfulness approaches in my own life, I think that this should just be seen as a personal preference and past-time. When the state, medicine, and MH services get involved a lot of what I value about mindfulness seems to get lost, and there also seem likely to be worrying social side-effects. It is not just revolutionary Marxists concerned about apathy, but also many in the Buddhist community are concerned about the way in which 'mindfulness' can be stripped of it's moral core and used as a way of managing a population's responses to injustice. Also, I'm uncomfortable with what seem to be some rather exaggerated claims about the value of mindfulness as a therapy. Whenever we exaggerate the likely benefits of cognitive interventions this encourages the notion that this with on-going distress are just not managing their minds correctly.

If the state wants to promote mindfulness to anyone, I suggest starting with those who have the most power in society, rather than those with the most distress. If those at the top learn how to distance themselves from their own egos and desires, I suspect that this may lead to rather less distress at the bottom.

I agree..working on a study at the moment seeing whether it might make a difference to the organisation and commissioning of mental health services if managers went on a course and had ongoing practice..Still faced with matter of funding at the end too.

In considering the concept of 'mindfulness' - it is worth remembering that the placebo effects derived from it - often have limited application as a therapy. Specifically, I have seen at first hand the damaging outcomes from its application to psychosis. Before the usual zealots claim, the expected unscientific claims let me explain further. As I understand the training in this area, the perceived benefit of existing in the moment, because of breathing or focusing on specific environmental variables - has been correlated with the amplification of distress associated with psychosis.

I am usually a fan of Huw's writings but I really struggled with this piece. For starters, I'm still left wondering what the post is actually trying to address. Is it that "mindfulness", as practised as part of therapy, is a bastardised form of the original Buddhist practice? Is it that mindfulness is inherently unethical because it creates distance from emotions? Is it that it is not evidence-based in psychosis? Is it that, by using mindfulness techniques, therapists are short-changing their clients by not directly addressing distress?

I was left with the sense that this was written by someone who doesn't have experience of using mindfulness as a cognitive and experiential tool in therapy, as opposed to the traditional Buddhist practice. I could be wrong, but that's the impression. Whilst the former was borne of the latter, I assert that they serve different purposes. Most therapy modalities (particularly CBT) require that people develop mindfulness in the most basic sense that they start to pay active-attention to internal experience. I think it is also rather inaccurate to state that it creates distance from emotions, is just about NOTICING, or that it somehow promotes escapism (which I infer from the rather patronising [though probably tongue-in-cheek] BREATHE references). Far from this, mindfulness as a cognitive capacity promotes the idea that one can own their internal experience without feeling they have to be directed by it; without being at the mercy of their minds. I disagree that mindfulness, as a cognitive and experiential tool in therapy, is concerned with the idea that there is no basic self. If that were so, I would be alarmed if therapists were using this philosophy with vulnerable people who may have lost (or not developed) any sense of self.

I feel quite guilty replying in opposition to the post in general because it clearly takes a lot of time and effort (and ability) to write so well on the subject mental health and psychology, and this is certainly not something I have done. I don't have any particular allegiance to mindfulness or otherwise either; maybe I've missed the point, which is entirely possible as Huw usually writes so well that I do struggle to keep up! If I have, please correct me!

The last paragraph says it all. Mindfulness - as part of an ancient theological system - has been commodified and divorced from its context for profit. It can be a very valuable tool for a variety of things but is probably best understood and applied by not being divorced from its deeper historical/theological context (that exists outside of and in stark contrast to the current commercial vacuum).

In Buddhism, there is something called "Lung" - it is "the meditator's disease and effectively it is psychosis. Meditating is like being in an isolation tank so it's best not to over-do it.

Treat meditating very carefully - a little goes a long way, and more is not better. If you go from nought to sixty very fast - i.e. beginners meditating for hours then you can expect problems - it is the same with physical exercise, if you try to do too much, you will strain a muscle. It is just the same with our brains.

there is an article about Lung here: http://fpmt.org/wp-content/uploads/sites/2/2004/08/LungTheMeditatorsDisease.pdf

Jon Kabat-Zinn says that yoga is meditating - and it's physical so that is better for people who are stuck in their heads.

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The Salomons Centre for Applied Psychology in Tunbridge Wells, England. We are part of the Canterbury Christ church University Department of Psychology, Politics and Sociology. We run training courses in Clinical Psychology and CBT and also practice improvement programmes for child and adolescent mental health services. On this site staff and trainees in the Department write about a wide range of issues related to applied psychology, psychological therapies, policy and health service development.